What factors contribute to hospital variation in obstetric transfusion rates?. Issue 1 (4th August 2014)

• Record Type: Journal Article
• Authors: Patterson, J. A.; Roberts, C. L.; Isbister, J. P.; Irving, D. O.; Nicholl, M. C.; Morris, J. M.; Ford, J. B.
• Is Part Of: Vox sanguinis. Volume 108:Issue 1(2015)
• Page Start: 37
• Page End: 45
• Publication Date: 2014-08-04
• Subjects: Blood -- Periodicals; Blood -- Transfusion -- Periodicals; Immunohematology -- Periodicals; Immunopathology -- Periodicals; 615.39
• DOI: 10.1111/vox.12186
• Languages: English
• ISSNs: 0042-9007

Abstract

<abstract abstract-type="main" id="vox12186-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="vox12186-sec-0001" sec-type="section"> <title>Background and Objectives</title> <p>To explore variation in red blood cell transfusion rates between hospitals, and the extent to which this can be explained. A secondary objective was to assess whether hospital transfusion rates are associated with maternal morbidity.</p> </sec> <sec id="vox12186-sec-0002" sec-type="section"> <title>Materials and Methods</title> <p>Linked hospital discharge and birth data were used to identify births (<italic>n</italic> = 279 145) in hospitals with at least 10 deliveries per annum between 2008 and 2010 in New South Wales, Australia. To investigate transfusion rates, a series of random‐effects multilevel logistic regression models were fitted, progressively adjusting for maternal, obstetric and hospital factors. Correlations between hospital transfusion and maternal, neonatal morbidity and readmission rates were assessed.</p> </sec> <sec id="vox12186-sec-0003" sec-type="section"> <title>Results</title> <p>Overall, the transfusion rate was 1·4% (hospital range 0·6–2·9) across 89 hospitals. Adjusting for maternal casemix reduced the variation between hospitals by 26%. Adjustment for obstetric interventions further reduced variation by 8% and a further 39% after adjustment for hospital type (range 1·1–2·0%). At a hospital level, high transfusion rates were moderately correlated with maternal morbidity (0·59, <italic>P</italic> = 0·01), but not with low Apgar scores (0·39, <italic>P</italic> = 0·08), or readmission rates (0·18, <italic>P</italic> = 0·29).</p> </sec> <sec id="vox12186-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Both casemix and practice differences contributed to the variation in transfusion rates between hospitals. The relationship between outcomes and transfusion rates was variable; however, low transfusion rates were not associated with worse outcomes.</p> </sec> </abstract>